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11D2205615 CLIA NUMBER - WALGREENS #10854

Laboratory Demographics

CLIA Number: 11D2205615

Facility Name: WALGREENS #10854

Facility Address:
2701 FAIRBURN ROAD
DOUGLASVILLE, GA
ZIP 30135
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Facility Phone Number: 404 556-6536

Facility Type: Other - COVID TEST SITE

Certificate Type: Waiver
NPI Number: 1023266921

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name Field Value
CLIA Number 11D2205615
LAB Type Other - COVID TEST SITE
Facility Name WALGREENS #10854
Street 2701 FAIRBURN ROAD
City DOUGLASVILLE
State GA
ZIP 30135
Phone 404 556-6536
CertificateType 4
CertificateEffectiveDate 12/15/2022
CertificateExpirationDate 12/14/2024
FacilityType Waiver

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This page was last updated on: 4/23/2024